患者可接受症状状态 (PASS)：全髋关节和膝关节置换患者的 EQ-5D-5L 和牛津髋关节和膝关节评分的阈值。
Patient acceptable symptom state (PASS): thresholds for the EQ-5D-5L and Oxford hip and knee scores for patients with total hip and knee replacement.
机构信息
Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
出版信息
Qual Life Res. 2023 Feb;32(2):519-530. doi: 10.1007/s11136-022-03287-9. Epub 2022 Nov 11.
PURPOSE
To define patient acceptable symptom state (PASS) cut-off values for the EQ-5D-5L and Oxford hip (OHS) and knee (OKS) scores 6 and 12 months after total hip (THR) or knee (TKR) replacement. To compare PASS cut-off values for the EQ-5D-5L scored using: (1) the Canadian value set, (2) the crosswalk value set, and (3) the equal weighted Level Sum Score (LSS).
METHODS
We mailed questionnaires to consecutive patients following surgeon referral for primary THR or TKR and at 6 and 12 months post-surgery. Patient reported outcome measures (PROMs) were the EQ-5D-5L, the OHS, and OKS. We assessed PASS cut-off values for PROMs using percentile and ROC methods, with the Youden Index.
RESULTS
Five hundred forty-two surgical patients (mean age, 64 years, 57% female, 49% THR) completed baseline and 12-month questionnaires. 89% of THR and 81% of TKR patients rated PASS as acceptable at 12 months. PASS cut-off values for THR for the EQ-5D-5L (Canadian) were 0.85 (percentile) and 0.84 (Youden) at 12 months. Cut-off values were similar for the LSS (0.85 and 0.85) and lower for the crosswalk value set (0.74 and 0.73), respectively. EQ-5D-5L cut-off values for TKR were Canadian, 0.77 (Percentile) and 0.78 (Youden), LSS, 0.75 and 0.80, and crosswalk, 0.67 and 0.74, respectively. Cut-off values 6 and 12 months post-surgery ranged from 38 to 39 for the OHS, and 28 to 36 for the OKS (range 0 worst to 48 best).
CONCLUSION
PASS cut-off values for the EQ-5D-5L and Oxford scores varied, not only between methods and timing of assessment, but also by different EQ-5D-5L value sets, which vary between countries. Because of this variation, PASS cut-off values are not necessarily generalizable to other populations of TJR patients. We advise caution in interpreting PROMs when using EQ-5D-5L PASS cut-off values developed in different countries. A standardization of methods is needed before published cut-off values can be used with confidence in other populations.
目的
定义全髋关节置换术（THR）或全膝关节置换术（TKR）后 6 个月和 12 个月时，EQ-5D-5L 以及牛津髋关节（OHS）和膝关节（OKS）评分的患者可接受症状状态（PASS）截断值。比较使用以下三种 EQ-5D-5L 评分的 PASS 截断值：（1）加拿大值集，（2）交叉值集，以及（3）等权重等级总和评分（LSS）。
方法
我们向接受初级 THR 或 TKR 手术的外科医生转诊的连续患者邮寄问卷，并在术后 6 个月和 12 个月进行随访。患者报告的结果测量（PROM）包括 EQ-5D-5L、OHS 和 OKS。我们使用百分位和 ROC 方法评估 PROM 的 PASS 截断值，并使用约登指数。
结果
542 例手术患者（平均年龄 64 岁，57%为女性，49%为 THR）完成了基线和 12 个月的问卷。89%的 THR 和 81%的 TKR 患者在 12 个月时认为 PASS 可接受。THR 患者 12 个月时 EQ-5D-5L（加拿大）的 PASS 截断值为 0.85（百分位）和 0.84（约登）。LSS 的截断值相似（0.85 和 0.85），而交叉值集的截断值较低（0.74 和 0.73）。TKR 的 EQ-5D-5L 截断值为加拿大，0.77（百分位）和 0.78（约登），LSS，0.75 和 0.80，交叉值集，0.67 和 0.74。术后 6 个月和 12 个月时，OHS 的截断值范围为 38 到 39，OKS 的截断值范围为 28 到 36（范围为 0 最差到 48 最好）。
结论
EQ-5D-5L 和牛津评分的 PASS 截断值不仅因评估方法和时间而异，而且因不同的 EQ-5D-5L 值集而异，这些值集在国家之间有所不同。由于这种差异，PASS 截断值不一定可以推广到其他 TJR 患者人群。当使用在不同国家开发的 EQ-5D-5L PASS 截断值时，我们建议对 PROM 结果的解释要谨慎。在其他人群中使用之前，需要对方法进行标准化，然后才能有信心使用已发布的截断值。
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